Clinical-laboratory characteristics of ANA-positive chronic idiopathic urticaria

Abstract

Despite the established association between chronic idiopathic/spontaneous urticaria (CIU) and presence of antinuclear antibodies (ANAs), the prevalence of autoimmune comorbidities in this population has not been analyzed. Here, we aim to identify clinical and laboratory manifestations associated with ANA-positive CIU. ANA-positive patients were identified via electronic data capture from the electronic patient record database of Leumit Health care Services (LHS) of Israel. Patient characteristics, medical histories, and details of diagnostic workup, medical treatment, and follow-up were retrieved by performing a chart review of electronic patient records (EPRs). The prevalence of target diseases among ANA(+) CIU(+), ANA(+) CIU(-), and ANA(-) CIU(+) patients was calculated. A total of 91 ANA(+) CIU(+), 3131 ANA(+) CIU(-), and 478 ANA(-) CIU(+) patients were identified. The ANA(+) CIU(+) group was characterized by higher prevalence of Sjögren's syndrome (SS)-A 52 antibodies (Ab) (7.7% versus 2.4%; p = 0.008), SS-A 60 Ab (11% versus 2.8%; p = < 0.001), and SS-B Ab (14.3% versus 3.2%; p < 0.001), compared with ANA(-) CIU(+) group. Additionally, ANA(+) CIU(+) patients were more likely to be diagnosed with thyroid autoimmune diseases, higher C-reactive protein (6.4 ± 10.3 versus 4.1 ± 8.8 mg/L; p = 0.027), and more profound basopenia (0.04 ± 0.09 versus 0.15 ± 0.11 cell/mm(3); p < 0.001) than ANA(-) CIU patients. More ANA(+) CIU(+) patients were resistant to four-fold standard licensed doses of antihistamines than ANA(-) CIU(+) patients [11 (12.1%) versus 29 (6.1%); p = 0.046]. ANA-positive CIU is characterized by higher prevalence of SS-A 52, SS-A 60, and SS-B antibodies and poorer clinical response to antihistamine medications.

Urticaria: Collegium Internationale Allergologicum (CIA) Update 2020

“…Rates of concomitant autoimmune diseases tend to be higher in type IIb [25,[118][119][120][121] Rates of concomitant allergic diseases might be higher in type I [119] Total IgE levels low in type IIb and normal or high in type I [14,25] Basopenia rates might be higher in type IIb [24, 111] 2 Eosinopenia rates tend to be higher in type IIb [122] C-reactive protein levels may be higher in type IIb [25,123] ANA positivity rates may be higher in type IIb [124] Responder rates to sgAHs may be lower in type IIb [122][123][124][125] Responder rates to omalizumab high in type I [28] and low in type IIb [62,122,126] Speed of response to omalizumab slow in type IIb [127] Immunosuppressive therapy can be effective in type IIb [128-134] 3 TPO, thyroperoxidase; TG, thyroglobulin; TF, tissue factor; IL, interleukin; dsDNA, double-stranded DNA; BHRA, basophil histamine release assay; BAT, basophil activation test; ASST, autologous serum skin test; WB, Western blot; ELISA, enzyme-linked immunosorbent assay; CRP, C-reactive protein; ANA, antinuclear antibodies; sgAHs, second-generation antihistamines. 1 Measured by ELISA or radioimmunoassay.…”

Chronic Spontaneous Urticaria Following Vaccination.

“…Patients with CSU are widely held to often have other autoimmune disorders, as well as the laboratory abnormalities suggesting autoimmunity (13,14). Remarkably, none of these manifestations were present in our patients prior to the first manifestations of CSU following vaccination, proposing that the vaccine may have been the triggering factor.…”

Abordagem Diagnóstica e Terapêutica da Urticária Crónica Espontânea: Recomendações em Portugal

“…80,81,84,86 Uma meta--análise recente, que incluiu um total de 14 203 doentes com urticária e 12 339 controlos sem urticária, concluiu que a prevalência de anticorpos anti-tiroideus era superior nos doentes com urticária, com OR entre 4,51 e 8,71, dependendo do anticorpo. 87 Alguns estudos estabelecem associações entre a presença de ANA e uma UCE refratária a terapêuticas de primeira e segunda linha, 35 entre a presença de ANA e a presença de anticorpos anti-tiroideus, 57 e entre esta combinação e a gravidade da urticária. 76 Um estudo reporta que a duração da UC está associada à sua gravidade, presença de angioedema, ASST positivo e anticorpos anti-tiroideus.…”